Michael Marcus, MD talks about the Swine Flu Facts and Stats.
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Pandemic Alert Levels were also is a confusing phenomenon. The Pandemic Alert Levels based on the World Health Organization are based on the spread of the virus itself, not the virulence of the virus, not the mortality rate of the virus, but merely the spread, how efficient and how sustain human to human transmission occurs. So we are now at level 6 Pandemic. It is world wide, it is easy transmissible and the degree of virulence is still to be identified. It's a concern as to how virulent it will be, but we just don't know yet. To give you some numbers though, in United States they just released the September statistics, over 16000 hospitalizations directly related to H1N1 in the United States, over 1300 deaths related to H1N1, 11 of them in children. So it is out there, it is across Southern states significantly, some Western states, we haven't seen it quite as much up here yet perhaps even if we got hit hard earlier in the Spring so there is some kind of immunity that evolve as well as we probably hope vaccination will do in order to decrease the numbers. But those are the September numbers just released yesterday by CDC. And this really is the proof of the pudding in terms of the danger of that shift. You could see that every time there is a major shift, this is the H1N1 shift, here is what H2 develops, here is where H3 develops and H1N1 comes back. Every time there is a shift you see a spike in the mortality rate of the new strength and it is been consistent for the last 80 plus years. But I think it gives us an understanding of what we are dealing with now that we another and some global shift, but now that we have an increase in the virulence and the transmissibility. 1918, I think this description really is very apt, As their lungs filled up, the patients became short of breath, increasingly cyanotic, gasping for several hours, they became delirious, incontinent, and many died struggling to clear their airways of a blood-tinged froth that some times gushed from nose and mouth. It is a dreadful business. Pretty good description of Pneumonia and Influenza that is as true today as then and really Pneumonia and lung disease is the primary complication and the most significant cause of ongoing morality and morbidity in Influenza. The things to remember is that you start with a primary like viral pneumonia, but secondary bacterial pneumonia is a leading cause of mortality when you take a look at postmortem specimens. And what we have seen for many years is that Pneumococcal infection is the most common cause of secondary mortality, but what we are now seeing is that MRSA is moving into the population and in the spring it was identified as a cause of mortality in the population as a whole. So certainly we want to make sure patients are vaccinated for their Pneumococcus, but only think about treating with anti-microbial considered both Pneumococcus and MRSA as the bacteria you need to cover for patients who are sick with Influenza Pneumonia where you are worried about that secondary infection. The other thing to remember is there are non-pulmonary complications and that's supposed to that excess mortality that we saw up in the graph and so Myositis, Encephalopathy, Myocarditis and other cardiac complications have clearly been identified and clearly are cause of more morbidities and causes of mortality with Influenza infection. Numbers we have seen before, 25 billion in 1918 died or infected in United States, and half the million died, worldwide they estimated 500 million people were sick and 20 or 100 million people died from Influenza during the pandemic. And ultimately more people died from Influenza pandemic than HIV as well as both World War I and World War II. And here is a wonderful book that was written, 'The Story of the Great Influenza Pandemic In 1918' and it's really very likely that the reason why World War I actually ended it was much more because of Influenza than any side actually winning the war. They were just